Gautam Santosh, Suso Alasana, Wood Elizabeth
Keough School of Global Affairs, University of Notre Dame, Notre Dame, Indiana, United States of America.
Masters in Global Affairs Program, Keough School of Global Affairs, University of Notre Dame, Notre Dame, Indiana, United States of America.
PLOS Glob Public Health. 2025 Jun 18;5(6):e0003880. doi: 10.1371/journal.pgph.0003880. eCollection 2025.
The prevalence of low birth weight (LBW) remains disproportionately high in sub-Saharan Africa. LBW is a significant risk factor for infant mortality and is associated with long-term physical and cognitive impairments. While antenatal care (ANC) has the potential to improve birth outcomes, there is limited causal evidence on its impact in sub-Saharan settings. This study estimates the causal effects of ANC on birth weight and LBW in The Gambia using data from the 2019-20 Gambia Demographic and Health Survey (GDHS). The GDHS recorded birth weight for 8,362 children born in the five years preceding the survey; after excluding cases with missing data, the final analytical sample included 4,443 children. Multivariable regression and propensity score matching (PSM) methods were used to assess the relationship between ANC and birth outcomes, controlling for child sex and birth order, maternal age and education, household wealth, marital status, rural residence, number of children under five, and regional fixed effects. Multivariable regression estimates indicate that each additional ANC visit is associated with a 22-gram increase in birth weight and a 1.2 percentage point reduction in the likelihood of LBW. Mothers who attended four or more ANC visits (ANC 4+) had a 3.9 percentage point lower risk of delivering an LBW infant compared to those with fewer visits. PSM analysis corroborated these findings, showing that ANC 4 + was associated with a 71-gram increase in birth weight and a 4.7 percentage point reduction in LBW probability. These findings highlight the importance of health policies that promote adequate ANC coverage to reduce the high burden of LBW in resource-limited settings.
在撒哈拉以南非洲地区，低出生体重（LBW）的患病率仍然高得不成比例。低出生体重是婴儿死亡的一个重要风险因素，并且与长期的身体和认知障碍有关。虽然产前护理（ANC）有改善分娩结局的潜力，但在撒哈拉以南地区，关于其影响的因果证据有限。本研究利用2019 - 20年冈比亚人口与健康调查（GDHS）的数据，估计了产前护理对冈比亚出生体重和低出生体重的因果效应。GDHS记录了在调查前五年出生的8362名儿童的出生体重；在排除数据缺失的病例后，最终的分析样本包括4443名儿童。采用多变量回归和倾向得分匹配（PSM）方法来评估产前护理与分娩结局之间的关系，同时控制儿童性别和出生顺序、母亲年龄和教育程度、家庭财富、婚姻状况、农村居住情况、五岁以下儿童数量以及地区固定效应。多变量回归估计表明，每增加一次产前护理就诊，出生体重增加22克，低出生体重的可能性降低1.2个百分点。与就诊次数较少的母亲相比，接受四次或更多次产前护理就诊（ANC 4 +）的母亲生下低出生体重婴儿的风险降低3.9个百分点。PSM分析证实了这些发现，表明ANC 4 +与出生体重增加71克以及低出生体重概率降低4.7个百分点相关。这些发现凸显了促进充分的产前护理覆盖以减轻资源有限环境中低出生体重高负担的卫生政策的重要性。
